直接淋巴管造影与CT淋巴管成像在继发性小肠淋巴管扩张症的回顾性研究  

Direct Lymphangiography with Sequential CT Lymphangiography in Secondary Intestinal Lymphangiectasia: A Retrospective Study

作　　者：董健[1] 信建峰 霍萌[1] 张春燕[1] 温廷国[1] 陈孝柏[1] 王仁贵[1] 沈文彬 DONG Jian;XIN Jianfeng;HUO Meng;et al(Beijing Shijitan Hospital ,Capital Medical University, Beijing 100038 ,P. R. China)

机构地区：[1]首都医科大学附属北京世纪坛医院放射中心,北京100038 [2]首都医科大学附属北京世纪坛医院淋巴外科,北京100038

出　　处：《临床放射学杂志》2018年第3期419-423,共5页Journal of Clinical Radiology

基　　金：首都临床特色应用研究项目(编号:Z13110700220000)

摘　　要：目的探讨直接淋巴管造影（DLG）后CT淋巴管成像（CTL）在继发性小肠淋巴管扩张症（SIL）中的诊断价值。方法回顾性分析SIL的患者资料共14例,平均年龄为47.1岁。所有患者均在DLG后行CTL检查,由两名放射科医师采用盲法分析图像。DLG评价内容：淋巴回流梗阻的部位,淋巴液对侧返流,异常扩张淋巴管,瘘,胸导管出口的回流障碍。CTL评价指标：小肠肠壁改变,水肿样病变及其范围,淋巴结,扩张淋巴管的分布及范围。结果与内镜及手术结果对照分析。结果 14例SIL的DLG结果：淋巴回流梗阻共3例,淋巴液对侧返流8例,异常扩张淋巴管9例,胸导管出口回流障碍12例,未发现瘘。CTL表现：小肠局部肠壁增厚11例,肠管扩张3例;水肿样病变：肠系膜水肿1例,腹腔积液9例,胸腔、腹腔积液3例,胸腔、腹腔合并心包积液1例;腹腔淋巴结3例;扩张淋巴管的分布与范围：14例均可见扩张淋巴管,其中腹段扩张3例,腹盆段淋巴管扩张4例,腹段、盆段合并胸段扩张4例,3例仅见于颈胸段;胸导管出口水平及周围扩张淋巴管,同侧10例,对侧3例;CTL在检出淋巴管扩张方面优于DLG。结论 DLG后CTL在SIL中具有重要诊断价值,对选择进一步治疗方案具有重要意义。Objective To explore the clinical value of direct lymphangiography（ DLG） with CT lymphangiography（ CTL） in secondary intestinal lymphangiectasia（ SIL）. Methods Forteen patients diagnosed as SIL with intestinal enteroscopy were included in this retrospective study. The patients were examined by DLG and CTL. Two radiologists reviewed all the images blindly. Subjective indexes of DLG included obstruction position of lymph drainage,collateral reflux of lymph fluid,lymphangiectasia,fistula and thoracic outlet dysfunction. For CTL,the indexes included the intestinal wall lesions,the presence and location of lymphoedema,lymph node,distribution and range of lymphangiectasia. All the diagnosis was compared with surgical results. Results The average age of SIL was 47. 1 years old. For DLG,3 cases of lymphatic drainage obstruction,8 cases of lymph fluid reflux,9 cases of lymphangiectasia,12 cases of thoracic outlets dysfunction,and no fistula was detected. For CTL,including（ 1） 11 bowel wall thickening and 3 intestinal lumen dilatation,（ 2） lymphedema,1 mesenteric edema,9 chylous ascites,3 chylothorax and chyloperitoneum,and 1 case with chylothorax,chyloperitoneum and chylopericardium,（ 3） 3 cases of lymph nodes,（ 4） lymphangiectasia,3 cases in abdomen only,4 in abdomen and pelvis,4 in thorax,abdomen and pelvis,and 3 only in thorax and neck,which is superior to DLG,（ 5） lymphangiectasia at peripheral area of thoracic duct outlet,10 in the ipsilateral side,and 3 in the contralateral side. Conclusion DLG with CTL demonstrates clinical feasibility in the diagnosis of SIL,especially for the therapeutic alternative.

关 键 词：继发性小肠淋巴管扩张症 内窥镜 直接淋巴管造影 淋巴管成像 体层摄影术 X线计算机 

分 类 号：R574[医药卫生—消化系统] R816.5[医药卫生—内科学]